Depressive symptoms and malnutrition are associated with other geriatric syndromes and increase risk for 30-Day readmission in hospitalized older adults: a prospective cohort study

Abstract

Background Readmission in older adults is typically complex with multiple contributing factors. We aim to examine how two prevalent and potentially modifiable geriatric conditions – depressive symptoms and malnutrition – relate to other geriatric syndromes and 30-day readmission in hospitalized older adults. Methods Consecutive admissions of patients ≥ 65 years to a general medical department were recruited over 16 months. Patients were screened for depression, malnutrition, delirium, cognitive impairment, and frailty at admission. Medical records were reviewed for poor oral intake and functional decline during hospitalization. Unplanned readmission within 30-days of discharge was tracked through the hospital’s electronic health records and follow-up telephone interviews. We use directed acyclic graphs (DAGs) to depict the relationship of depressive symptoms and malnutrition with geriatric syndromes that constitute covariates of interest and 30-day readmission outcome. Multiple logistic regression was performed for the independent associations of depressive symptoms and malnutrition with 30-day readmission, adjusting for variables based on DAG-identified minimal adjustment set. Results We recruited 1619 consecutive admissions, with mean age 76.4 (7.9) years and 51.3% females. 30-day readmission occurred in 331 (22.0%) of 1,507 patients with follow-up data. Depressive symptoms, malnutrition, higher comorbidity burden, hospitalization in the one-year preceding index admission, frailty, delirium, as well as functional decline and poor oral intake during the index admission, were more commonly observed among patients who were readmitted within 30 days of discharge (P < 0.05). Patients with active depressive symptoms were significantly more likely to be frail (OR = 1.62, 95% CI 1.22–2.16), had poor oral intake (OR = 1.35, 95% CI 1.02–1.79) and functional decline during admission (OR = 1.58, 95% CI 1.11–2.23). Malnutrition at admission was significantly associated with frailty (OR = 1.53, 95% CI 1.07–2.19), delirium (OR = 2.33, 95% CI 1.60–3.39) cognitive impairment (OR = 1.88, 95% CI 1.39–2.54) and poor oral intake during hospitalization (OR = 2.70, 95% CI 2.01–3.64). In minimal adjustment set identified by DAG, depressive symptoms (OR = 1.38, 95% CI 1.02–1.86) remained significantly associated with 30-day readmission. The association of malnutrition with 30-day readmission was no longer statistically significant after adjusting for age, ethnicity and depressive symptoms in the minimal adjustment set (OR = 1.40, 95% CI 0.99–1.98). Conclusion The observed causal associations support screening and targeted interventions for depressive symptoms and malnutrition during admission and in the post-acute period.

Improving nutrition care and diet intake for hospitalised older people at risk of malnutrition through a nurse‐driven mealtime assistance bundle

“…The proportion of the older people with poor dietary intake in the pre‐implementation group was similar to that of a previous local study by Laura et al. (2022). However, a reduction in the proportion of older people with poor dietary intake, and the increase in total meal and protein intake were observed, despite the post‐implementation group being older, and more likely to present with nutritional risk factors.…”

“…This QI project demonstrated that a nurse-driven mealtime assistance bundle may improve the dietary intake of hospitalised older people who are at risk of malnutrition. The proportion of the older people with poor dietary intake in the pre-implementation group was similar to that of a previous local study by Laura et al (2022).…”

Prevalence and outcomes of frailty in unplanned hospital admissions: a systematic review and meta-analysis of hospital-wide and general (internal) medicine cohorts

“…We screened 14,006 abstracts and 2287 full texts, from which 45 cohorts (n = 39,041,266 admissions, 49 publications) 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 were eligible for inclusion ( Fig. 1 ).…”

Effectiveness and complications of transcrestal sinus floor elevation using the cushioned grind‐out technique: A retrospective cohort study with up to 7 years of follow‐up

“…Third, multiple association studies were conducted on the variables. Directed acyclic graphs (DAGs) were used to initially select potential influencing factors (Laura et al, 2022), and based on that, mediators were excluded. The ICCs measure the degree of clustering of three essential aspects (ESBG, Schneiderian membrane perforation and implant survival) and were 0.438, 0.314 and 0.681, respectively.…”